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Home My WebLink About10079 (5)CITY OF DIAMOND BAR 1 COMMUNITY DEVELOPMENT DEPARTMENT ,,� 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 1�'%AMt, RI 111.1]TNCT PERMIT APPLICATION JOBSITE ADDRESS l� APN T TRACT OWNER '660 4f�I ADDRESS IPIF�c CITY +jr ZIP TE APPLICANT TEL 1, CONTRACTOR ADDRESS /. ✓ — CITY zllp� ARCHIENGI DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U - CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 SUSINESSAND PROFESSIONS CODE: ANY CITYOR COUNTY WHICH REQUIRESAPERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC. TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($600) ): ❑ I.ASOWNEROFTHE PROPERTY, OR MYEMPLOYFES WITH WAGES ASTHEIR SOdfCOMPENSATION. WILL. DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FO ALE (SEC. 7044, BUSI- NESSAND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUC RK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMP VEMENTSARE NOT INTENDEDOR OFFERED FOR SALE. IF, HOWEVER, THE BUILDING OR IMPROVEME SOLD WITHIN ONE YEAR OF COM PLE- TKON. THE OWNER•BUJUDEA WILL HAVE THE BURDEN OF PR THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVE CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, SUSINES ND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOT APPLY TO AN OWNER OF A OPERTY WHO BUILDS OR IMPROVESTHERFON.AND WHOCONTRACTS FOR SUCH PRDJECTSWITHACONTRACTOR(S)LICENSEDPURSUANT TOTHECONTRAC- TORS LICENSE LAW.). O I AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULLFORCEFORRCE AND EFFECT. LICENS �S fir) LIC. NO. , 4�" DATE CONTRACTOR e. WORKERS' COMPENSATION DECLARATION` --I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: r HAVE ANDWILL MAINTAINACERTIFIGATE OF CONSENT TO SELF -INSURE FOR WORKE S' COMPENSATION. AS PROVIDED BY. SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3 70 0 OF THE LABORfff��j��qqggqUDE, FOR HE PE FORMANCF F THE WORN FOR WHICH THIS PERMITIS ISSUED. MV WORIi1PE AT U INSURAN CARRIER AND POLICY NUMBER ARE: CARRIER YY.,//''"" t POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OFTHE PERMIT LS FORONE HUNDRED (51 )OR I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECTTOTHE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHO LD BECOME SUBI TO THE WORNERS'COMP R YISXONSO ECT ION FTHE LABOR 0 I S Try FORTHWITH COMPLY WIT P SI DATE: 2 7 APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, D ALL SE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDR T IT DOLLARS($100,DDD), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVI DO IN SECTION 37D9 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME -- LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPE N) PURPOSES. P ITT I=( ( INT) e'"! SIGNATURE OF ER ER DATE PRESS FIRMLY APPLICATION DATE ISSUE DATE 111 —_ PERMIT PIC NUMBER # TYPE OCC CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDEISIDE STREET RW SIDE ❑ ❑ ❑ ❑ PROPOSED USE NO. DWEL. UNITS NO, STORIES NO. BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREANALUATION SFR/ADD(REM Garage/Carport WPafio/Deck LL POoVSpa ZFte•RQof 0 Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE —N U ga ev-A.1apc5 r a Lu it tale - CCONSTRUCTION CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: APR 0 (' a Q• TOTAL FEES COMMENTS ` RECPT. NO--� ID BY VALIDATION WHITE—Department Copy, YELLOW --Finance Copy, PINK --Assessor copy, GV WCrBiVIJ—e•ne L:opy, UHttrv—Appncanrs wpy ...:.:,.�ru:q r-.. ,.;,. ,t;.. ..,� .. �?::,•:, rr ::; e:.a ., rak+ .tl . rt ''S' � k.i:. � i kh "+ , c, ., .. , ..-'r:.:h,Wi,•. V i.' .. *t4 '... .. r .. .4.. .... F,5's/" .. CI C�1� BAS ,yj '�H INSPECTION RECORP, SET BACK;:. „ .. _ FU µms.. FrGS/FORM SIS'T EEL_ _ ELECTRIC GROUND 2y., UN GROUND PLUMBING U(V SLAB GRADE B �� TEMP POWER FIF WATER SERVICE GNAT _ ROOFSHEATHING 8 F FRAMINGI�BEN1 IIATBON ry 3r ROOF COVER � liOL161-IhIEATINC®� ® BE ROUGH ELECTRIC E �0 ROUGH PLUMBING - y. t^iR SHOWERJTUB TEST - -_ _-.-°_ EXT LATH/SIDING PO WALL INSULATION po CEILING INSULATION 6F DRYV"JALL NAILING j, DE _SEWE 9 ... SEPTIC TANK. LAI SEEP PITJL.L: _ _ ,.. ON GAS AIR TEST FINAL: CONST. n FI I FINAL- . �,� _._ FINAL 1=LECTRIC '`% DE FINAL PLUMBING EN COMMENT t �^ SEPTIC TANK SIZE SEEP PIT/U SIZE :. rY,...:''AAI a ;,vl: 4 14' ' :f 'i'r1 hi., v : :7A5,' r.: ♦ .. rn. :. � �-lam,' - _.._...........__._. ......, .__.... ..._ . _....... _._ ,. .,. r. i=�:- � ..Ly.:.i. r.+.v r- :',• i r 5,: .. ..... .. .:..eS. .. .-, .. ... .. ..,-_._'_.e.�.._.�s_..e..v.Y._..._d